Wall injury could help Wiz in short and long term

Wall injury could help Wiz in short and long term

It was time. The bone spur in his left heel was just too painful and surgery was necessary, even if it ended his season. The season was going sideways, anyway.

Yes, the star point guard had just signed the richest contract in NBA history, over $150 million. But this is likely best for the long-term, for the individual and the organization. Plus, it might just help add the team’s next star in the draft.

Oh, you thought I was talking about John Wall?

My bad. I was actually talking about Mike Conley, who underwent season-ending surgery last January to smooth a bone spur in his left heel. This appears to be a similar injury to the one that Wall is dealing with at the moment.

As one person close to the situation described the injury to NBC Sports, Wall has a “spur stuck in his Achilles and it won’t calm down. Probably need to look at the big picture.”

For frustrated Washington Wizards fans, that big picture may look a lot like the current Memphis Grizzlies. Conley’s season-ending surgery in late January eventually led to the No. overall 4 pick and Jaren Jackson Jr., who looks every bit like the future star of a rejuvenated Grizzlies franchise.

The Wizards still have their 2019 first-round pick, which, at the moment, might be the team’s most valuable asset. According to Tankathon.com, the Wizards have a 37.2 percent chance of landing a top-four pick.

The 2019 draft will be the first with the NBA’s reformed draft lottery odds. Under the new rules, the teams with the three worst records have an equal 14 percent chance of receiving the No. 1 pick. The team with the fourth-worst record has a 12.5 percent chance, an almost negligible difference of odds. In years past, the NBA drew ping-pong balls for the top-three picks. Now, it’s four.

The big question is whether the organization shifts into rebuilding mode. And that decision is going to be a difficult one now that the Wizards have already traded 26-year-old Austin Rivers and 23-year-old Kelly Oubre Jr. for veteran Trevor Ariza. That’s a win-now move, not a rebuilding move. If they want to go the youth movement and jockey for draft positioning, letting Rivers and Oubre play through their mistakes would’ve been an easy shift.

However, they may not have to shift at all. The Wizards have been playing like a lottery team over the last month or so, going 2-8 over their last 10 games. Even before Wall’s season-ending diagnosis, the Wizards were battered and bruised. Dwight Howard might be months from returning. Markieff Morris and Otto Porter both sat out Friday’s game with minor injuries. To make matters worse, Sam Dekker turned his ankle and left the game as well.

No doubt that the Wall news is a tough pill to swallow for the Wizards faithful, but this might be a blessing in disguise. Yes, fans might look at his average annual salary of $42.5 million through 2022-23 and cringe even more. But that max extension is precisely why you might opt for surgery now.

Does having bone spurs in your heel that grind into your Achilles tendon sound like something you want to aggravate by playing another 50 or so games? No. This is the smart course of action because of that enormous investment that the Wizards made in Wall. After surgery and a full summer of rehab, Conley is playing some of the best ball of his career, averaging 20.3 points and tying a career high with 6.5 assists in Year 3 of a five-year max extension.

Also, the Wizards don’t have to throw in the towel just yet. If last season is any indication, they might be able to turn things around. When Wall went out in late January, the Wizards uncorked a five-game win streak and ended up going 15-12 in the 27 games he missed.

We also might see a different Otto Porter now that Wall is sidelined. In the 121 minutes that Porter has played without Wall this season, he has played like the star they envisioned, averaging 19.6 points, 8.3 rebounds per 36 minutes while shooting 52 percent from the floor and 38.9 percent from deep, per NBA.com tracking. Those numbers shrink to 13.2 points, 6.6 rebounds and 47 percent shooting with Wall on the floor. Last season, a similar trend followed: Porter’s numbers ballooned without Wall across the board.

Wall’s backup, Tomas Satoransky, could see a big boost as well after his breakout performance during Wall’s absence last season. Though he didn’t wow anybody in the disappointing loss to Chicago on Friday, the 27-year-old big combo guard can be a change of pace for the team. Though he’s not a natural pick-and-roll point guard, he can be creative in transition and run with Bradley Beal.

Beal might also be able to turn this adversity into an opportunity. The 25-year-old has watched his assist rate grow for the fourth straight season and that should only continue in Wall’s absence. The Wizards have actually been plus-23 in 341 minutes this season when Beal plays without Wall. Beal’s assist rate jumps from 4.1 per 36 minutes with Wall to 6.1 assists per 36 minutes without him. (When they’ve shared the court this season, they’ve been minus-110 in 977 minutes, per NBA.com tracking. Yikes.)

The question is whether they want to try to eke into the playoffs at all. The worst-case scenario would be just missing the playoffs and sitting outside of the top 10 in next year’s draft. That’s a very real possibility considering that the Wizards have only 26-percent odds to make the playoffs, per FiveThirtyEight tracking and just 1.3-percent odds, per Basketball-Reference.com’s simulations.

It might be prudent to see Wall and Howard’s injuries and admit that it’s time to build for next season. Let promising 21-year-old Thomas Bryant bang in the post against the NBA’s best. See what you have in 19-year-old Troy Brown Jr. -- the team’s next “Jr.” swingman waiting in the wings. Give Dekker and Ron Baker every chance to prove they belong in the league.

Memphis was 17-31 when Conley announced his season-ending bone spur surgery last season. They handed the keys to Marc Gasol and the kids. They lost 29 of the last 34 games of the season and ended up with maybe the most promising big man of the 2018 class in Jackson Jr.

Can the Wizards make the same gamble? With the draft lottery flattening out for the top-four picks this year, this might be just the time to find Wall and Beal’s next running mate.

Weight and see: The Boogie Cousins conundrum

Weight and see: The Boogie Cousins conundrum

He is listed at 270 pounds, making him one of the 10 heaviest players in a league of mountainous men. According to a recent CDC study, the average American male in his twenties checks in at 5-foot-9, 187 pounds -- a 6-foot-2 male is considered to be in the 95th percentile. Cousins is 6-foot-11, and nearly 100 pounds above the norm.

As Cousins returns from a ruptured Achilles on Friday night against the Clippers, the NBA world will be watching closely. How will he look? Will the Warriors play through him? How many minutes will he play? Will he be a liability? Will he be All-NBA again?

Those questions won’t be limited to just basketball people. The medical community will surely be keeping an eye on Cousins’ return simply because he is such a rare case study.

Even in the NBA, where the average height is 6-foot-7 and the average weight is 218 pounds, there aren’t many examples of players as large as Cousins returning to play at a high level. And if they are that large, they aren’t All-NBA players. And even if they were All-NBA players, they aren’t returning to a team looking to win a third straight championship.

What’s at stake isn’t just the Warriors’ chances at a three-peat. Cousins is a free agent this summer. The key to maximizing both may be one simple variable: Cousins’ weight.

Cousins’ weight and conditioning have been a talking point throughout his basketball career. At Kentucky, he was listed at 292 pounds by DraftExpress. He ballooned to 308 pounds by the end of the 2015-16 season, per Basketball Insiders’ Steve Kyler, before trimming down to 275 ahead of Team USA camp in the summer of 2016.

“He’s gotten in unbelievable shape for this,” Team USA coach Mike Krzyzewski said of Cousins that summer.

His weight again swelled during the 2016-17 season around the time of the blockbuster trade from Sacramento to New Orleans. That following summer, he wanted to shed some pounds, so he hired a new personal chef and dedicated himself to yoga.

“I kind of let myself go in the second half of the season last year,” Cousins told NOLA.com in August 2017. “I got in a place where I didn’t really want to be.”

Cousins lost a bunch of weight to prepare for the 2017-18 Pelicans’ up-tempo pace, though he didn’t specify how many pounds he lost, telling ESPN: “I don’t know. I really don’t know. I lost a lot of weight.”

The funny thing is, despite the obvious body transformations, Cousins’ weight never wavered in his team’s official media guides over the years. His weight was listed at exactly 270 pounds for every season -- in Sacramento, in New Orleans and now, in Golden State. Hardly anyone around the league believes that to be an accurate figure. Just like his teammate Kevin Durant’s height of 6-foot-9.

But Cousins’ weight will be critical during his return from the Achilles injury. According to proprietary research done by the Sports Medicine Analytics Research Team (SMART) and obtained by NBCSports.com, one factor stood out in NBA players’ ability to return to pre-Achilles-tear levels: Weight loss.

The study looked at 40 Achilles tears in the NBA and tracked each player’s performance after surgery. Some went well. More did not. But of the list of positive outcomes, all but one case was associated with weight loss.

It’s not clear how much weight Cousins lost during his Achilles rehab, if any. While there were a slew of articles detailing his weight loss during the 2017 offseason, that hasn’t been a focal point this time around. The Warriors’ media guide lists him at 270 pounds, the same as it was in Sacramento.

The post-Achilles study found that no players above 285 pounds were able to return to greater than 70 percent of their PER or scoring average after injury. No players above 285 pounds were able to play more than 66 percent of their games or have performance levels within 50 percent of their prior level.

Dr. Richard Ferkel of the Southern California Orthopedic Institute estimates that he’s operated on over a dozen Achilles tears of NBA players in his medical career. Cousins was one of them last January. He agrees that Cousins’ sheer weight makes for a trickier recovery, but he’s been very pleased by the collective effort by Cousins and the Warriors staff. Keeping his weight down has been a top priority.

“It certainly is a factor,” Dr. Ferkel told NBCSports.com. “The stress they’re putting on is a little different than for somebody who is a six-foot point guard. It probably extends the rehab a bit longer in bigger people than in smaller people.”

There’s a litany of cautionary tales for centers dealing with this injury, but former McDonald’s All-American center Stanley Roberts, Shaquille O’Neal’s 7-foot teammate at LSU and former first-round pick, is one of the more infamous examples. In December 1993, Roberts ruptured his right Achilles. Ten months after his surgery, Roberts showed up to Clippers training camp well over 300 pounds. Said then-Clippers GM Elgin Baylor: “He weighs too much, that’s what he weighs. You can quote that.” Three weeks later, Roberts ruptured his left Achilles tendon. He admirably fought his way back to play part of five seasons, but he played his last NBA game before turning 30 years old.

The injury also ended the career of the 300-pound Jerome James, who famously signed a five-year, $30 million contract with the Knicks in 2005 and dealt with weight and health issues throughout his New York tenure before tearing his Achilles in 2008. In 2011, DeSagana Diop, listed at 300 pounds, tore his Achilles at the age of 28 and played just 49 games thereafter. None of these giants were near All-NBA players at the time of injury, but they shared Cousins’ colossal size.

Why is weight loss such a strong predictor? It has to do with one devastating side effect of a torn Achilles: Calf atrophy. Because of the post-surgery immobilization, the calf muscle shrinks from the lack of exertion. Simply put, the smaller muscle often times can’t support the same weight as it did before the surgery. That imbalance is super tricky to manage. Studies have shown that even after seven years post-surgery, the calf muscle on the injured side of Achilles tears showed decreased strength compared to the non-injured side.

After a recent full-contact practice at Santa Cruz, Cousins was asked whether he was nervous about his Achilles holding up.

"No nervousness at all," Cousins told ESPN. "I'm more worried about pulling a hammy or something like that. It's been a while since I've played and reacted. The Achilles is the least of my worries."

Cousins’ nerves about other things being thrown off is a worthy concern. It’s exactly what happened to a star big man who suffered an Achilles tear about a decade ago.

* * *

Elton Brand is often cited as the closest Cousins comp. You’ve probably heard that Brand’s Achilles tear in 2007 derailed his career. Actually, you might have heard that directly from him, in a podcast interview with ESPN’s Marc Spears and Amin Elhassan.

“The most frustrating part was the injuries,” Brand said. “That Achilles really changed the trajectory of my career.”

At the time of his injury, the two-time All-Star was 28 years old and listed at 254 pounds, down from his 275-pound rookie weight. In Brand’s post-surgery April debut, he scored 19 points in 26 minutes off the bench, returning in about eight months, three months sooner than Cousins’ timetable. Brand averaged 17.6 points and 8.0 rebounds in the final eight games of the season, down from his pre-injury levels of 20.5 points and 9.3 rebounds. But, surprisingly, after adjusting for playing time, Brand’s per-minute averages in 2007-08 were nearly identical to his pre-surgery norm. After signing with the Philadelphia 76ers, Brand averaged an impressive 17.4 points and 10.3 rebounds in 18 games to kick off his tenure.

But in early December with the Sixers, Brand suffered a right hamstring injury against the Lakers, and two weeks later, he dislocated his right shoulder, which required season-ending surgery to repair a torn labrum. Then, after all those injuries, he was never the same again.

“That whole kinetic chain: Once you get the calf, it’s the ankle, the knee, the hips, the back,” Brand told ESPN. “No one’s really recovered from that Achilles injury and come back at the same level. I had a few serviceable seasons, but I wasn’t the same guy.”

It’s impossible to know how Brand would fare if he hadn’t busted his hamstring and then wrecked his shoulder. But those are certainly contributing factors to his post-surgery drop off and something to keep in mind while fortune-telling Cousins’ next few months.

Brand is just one example of a big man who struggled to regain his pre-surgery form. But it’s instructive to look at some possible potholes to avoid with Cousins. In Brand’s first full season after his Achilles tear, he played in both parts of a back-to-back in the second game and third game of the season. In the second night, after flying overnight from Philadelphia to Atlanta, Brand played 45 minutes. Yeah, it was a different league back then.

Sitting out the second half of a back-to-back was once considered taboo but not anymore. Team sources indicate that they haven’t discussed whether Cousins will play in back-to-backs this season, choosing to play it by ear. But it could be wise to sit him in those games. When Brand suffered his pulled hamstring on Dec. 3 against the Lakers, it was his third game in four nights. He played 41 minutes in the first game and 43 minutes in the second. In the third game, also the second night of a back-to-back, Brand came up limp halfway through the third quarter. He pulled his right hamstring, the opposite leg of his Achilles tear.

As good as Brand was, the Duke product was never quite the caliber of Cousins, who already has twice the number of All-Star appearances as Brand. Add the backdrop of a championship quest and this is uncharted territory.

Cousins is returning to a new team and a new, high-octane league. He will be suiting up for a Warriors team that is averaging 101.7 possessions per game, the 10th-highest pace factor in the league. That’s actually a tad faster than the Pelicans’ pace -- 100.6 possessions per game -- at the time of Cousins’ injury in late January.

Can Cousins play at that kind of pace? It’s a question that will be on Dr. Ferkel’s mind when he watches Cousins in person on Friday in Los Angeles.

“No. 1, how does he feel and look on the court?” Ferkel says. “How comfortable is he? How comfortable is he to keep up with the pace of the game?”

The Warriors have slowed down lately, perhaps in anticipation of bringing in Cousins. In the month of December, the team ranked second in fastest offensive possessions, pushing the ball at every opportunity, per Inpredictable.com tracking data. But in January, they’ve tapped the brakes down to eighth-fastest, most notably after turnovers, where the offense ranks below-average in speed. The Pelicans were demonstrably faster when Cousins hit the bench last season. The Warriors figure to follow suit.

In some ways, Cousins’ return couldn’t happen at a better time. The Warriors have a preposterous 130.1 offensive rating this month, and that’s before they add a guy who averaged 25.2 points last season before going down with his Achilles injury.

But Dr. Ferkel emphasized that what we’ll see on Friday isn’t the final product. In some ways, it’s the beginning.

“I think it’s important for people to understand that even if he’s released, we, as part of DeMarcus’ team, feel this current release [to play] is really the final phase of his rehabilitation. We’re not saying he’s 100 percent like he would be if he was uninjured. He’s done everything he can do but be in a game situation with elite players.”

After Cousins passed his conditioning tests, the final barrier to play, he was cleared to play for the champs. The wait is over. But for his long-term health, the weight watch has just begun.

Harden checks every box. Traditionalists will love his eye-popping scoring average (he’s leading the scoring title by full 5.0 points, which would be the largest gap since Michael Jordan's 1986-87 season when he averaged 37.1 to Dominique Wilkins' 29.0) and triple-doubles combined with the narrative that he’s “carrying” the Chris Paul-less Rockets. The nerdier voters will appreciate his freakish efficiency (his current true-shooting percentage tops Michael Jordan and Kobe Bryant’s best) and off-the-charts offensive RPM. Both ends of the spectrum can get behind Harden.

Put it this way: Who has raised a team’s championship odds more this season?

You could make a strong case for Milwaukee’s Giannis Antetokounmpo, whose Bucks have the NBA’s best net-rating at plus-9.2. But the addition of head coach Mike Budenholzer, who overhauled both ends of the floor, muddies the picture for the Greek Freak. Who deserves credit for the Bucks’ rise?

That question is easier to answer for the Rockets. It seems like a lifetime ago, but only one month has passed since Houston general manager Daryl Morey came on The Habershow podcast with the 11-12 Rockets reeling in the wake of the Carmelo Anthony debacle. Rather than retreat, Morey doubled down: “We feel like we can be better than last year. I know I sound crazy saying that.”

Shortly after that, Paul got hurt, and the Rockets went on a tear, Harden leading the way. Over the past 14 games, Harden has averaged 40.3 points and 9.4 assists while shooting 40.2 percent on a whopping 14.9 3-pointers per game. To put that into perspective, Harden averaged 30.4 points and 8.8 assists while shooting 36.7 percent on 10 3-pointers per game during his MVP campaign last season.

The difference between last year’s campaign and this one? Harden has turned the step-back 3 into a basketball superpower. He’s getting defenders off balance and routinely racking up three-shot fouls, which is the most profitable play in the game. Peruse the Basketball-Reference logs and you’ll find that Harden has accumulated 38 three-shot fouls this season. That’s more than Damian Lillard (16), Stephen Curry (10) and JJ Redick (8) combined. He used to hunt for the three-shot foul in pick-and-rolls, but the league started cracking down on it. Now, he’s getting it with the step-back 3.

While Harden has my vote for first-half MVP, I’m a tad concerned that he’ll wear down. He’s leading the league in minutes per game and the Rockets are paper-thin at the guard position. Case-in-point: Free-agent pickup Austin Rivers is averaging a team-high 38.5 minutes per game in his eight contests with the team. Harden’s MVP candidacy may be dented by Paul’s eventual return, but they need more bodies to win at the highest level.

Antetokounmpo may have taken the lead in the larger MVP conversation after Wednesday’s victory over the Rockets, but I’m still leaning Harden, who is averaging 20.2 assist points per game in addition to his own scoring. Also in the running is Joel Embiid, who is putting up Shaq-like numbers for the Sixers, and Paul George, who might be the best two-way player in the game. Speaking of George...

The Thunder have the NBA’s best defense by a good margin despite not having Andre Roberson, who might've been the best perimeter defender in the league last season.

George has snatched that distinction from Roberson this year. Here’s a list of guys he’s guarded for at least 10 possessions this season: James Harden, Kevin Durant, Kemba Walker, Luka Doncic, Jrue Holiday, Klay Thompson and Devin Booker. That versatility enables the Thunder to blanket opponents on the perimeter while Steven Adams mans the middle and owns the backline. George’s on-court defensive rating of 99.9 is second-best for any player among the 84 players averaging at least 30 minutes per game, per NBA.com. Some of that is due to Adams, but George leads all players in deflections and loose balls recovered. He’s everywhere.

Gobert may end up winning this award again now that the Jazz have overcome a funky start on that end of the floor, but his on-off splits haven’t been nearly as stark as last season. Embiid, for his part, has defended the most shots at the rim in the NBA and held opponents to a crazy-low 54.2 percent on those shots. Holiday is a 6-foot-4 straitjacket, but for this award, I can’t ignore that the Pelicans have a bottom-six defensive rating.

Ultimately, George has earned this spot. In today’s 3-point-heavy league, lock-down perimeter defenders are more valuable than ever. With Kawhi Leonard sitting out games to rest, George has ascended to become the gold standard on that end of the floor.

It feels odd to hand this award to the coach of a team that’s been hovering around .500 all season, but the Kings might hit their Vegas over/under projection before the All-Star break.

It’s not just some lucky wins here and there. Joerger has completely overhauled their playing style and tailored it for young legs. Last season, their offensive possessions lasted 15.4 seconds on average, the third-slowest pace in the league, per Inpredictable.com. This season? Joerger has handed the keys to De’Aaron Fox and Buddy Hield and the results are a group averaging 13.1 seconds on offense, which is the second-quickest rate in the league. They’re running teams out of the gym.

Despite the fifth-youngest roster in the league, the Kings are also holding their own in clutch situations. Per NBA.com tracking, the Kings are 14-10 when the game is within five points in the final five minutes, a better record than the Boston Celtics, Golden State Warriors, San Antonio Spurs and the LeBron-led Los Angeles Lakers.

Who says young teams can’t win in the NBA? To me, the Kings are the biggest surprise of the season and this award reflects that.

This guy is an absolute stud. The 22-year-old has been a monster for the Pacers’ nasty second unit along with Tyreke Evans and Cory Joseph. Over the last 10 games, the son of the legendary Arvydas Sabonis is averaging 17.6 points and 8.7 rebounds on 60.7 percent shooting and providing stout defense up front. He doesn’t have Anthony Davis’ wingspan, but he doesn’t need it to make an impact defensively. He has allowed the fewest points per possession on plays against him (.771), according to Synergy tracking (minimum 300 plays defended).

The only red flag here? Sabonis might not be a bench player for long. Thaddeus Young just won an East Player of the Week award, but Sabonis deserves the starting gig, and soon. Sabonis is averaging 21.3 points, 13.6 rebounds and 4.3 assists per 36 minutes this season with great touch around the rim and a nice pick-and-pop game in the mid-range. If he can re-discover his 3-point stroke, he could be Kevin Love 2.0 (who also came off the bench at the beginning of his career).

With Myles Turner, Young and Sabonis, Indiana suddenly has a logjam in the frontcourt, but don’t be surprised if the Pacers -- who also have Kyle O’Quinn as insurance -- make a move to free up some starter minutes for Sabonis. He’s earned them.

If Sabonis does move off the bench, there are several other candidates of consideration. Spencer Dinwiddie is the new Lou Williams (who also deserves plenty of votes). Derrick Rose has started over a third of his games, which might disqualify him in many eyes, but he’s been a revelation this season. When it comes to picking between Sabonis or Montrezl Harrell, you’re splitting hairs at this point. Both have been incredible supersubs, but Sabonis’ playmaking and rebounding gives him the edge.

You could make a case here for a few guys in this loaded class and I wouldn’t mind. But to me, no one has been more dominant than Doncic, who is the only rookie in the top 50 of ESPN’s RPM. As last week’s BIG Number illustrates, Doncic, as a teenager, is putting up numbers we haven’t seen since LeBron James. Only James Harden tallied more free throws than Doncic in the month of December, which is downright absurd for a teenager.

Like Harden, Doncic has used the “slow” or “unathletic” label to his advantage -- starting and stopping on a dime and capitalizing on the defender’s overeagerness to draw fouls. Doncic’s expert tempo and court awareness has more than made up for a perceived lack of athleticism. Only 6.6 percent of Doncic’s 2-pointers have been blocked this season, per pbpstats.com, which is lower than that of leapers like LeBron James (7.0), Giannis Antetokounmpo (8.0) and Andrew Wiggins (8.8 percent) -- and nearly half that of Zach LaVine (13.6).

In any normal year, Ayton, Jackson and Carter Jr., could win but not when Doncic is averaging 19.8 points, 6.7 rebounds and 4.8 assists for a team that holds a positive point margin. The seemingly slow Doncic has picked up the NBA game mighty quick.

Often times, Most Improved Player is misinterpreted as Most Minutes-Improved Player, but you can’t say that about Fox, who is just plain better than he was last season. The 21-year-old went from averaging 11.6 points, 4.4 assists and 2.7 free throw attempts per game last season to 18.0 points, 7.3 rebounds and 5.3 attempts per game this season (he’s only playing 3.9 more minutes per game). Usually, we see turnovers soar with the larger burden, but not in Fox’s case.

There’s some pace inflation in those stats because of the Kings’ new run-and-gun offense. But you know who makes all that possible? That’s right: Fox. Despite only playing 31.7 minutes per game, he’s sixth in the NBA in total transition points, per Synergy Sports tracking, while also helping Buddy Hield rank second on that same list. This season, Fox has posted a higher player-efficiency rating (19.0) and win-shares total (3.0) than his draft classmates Jayson Tatum, Donovan Mitchell, Lonzo Ball and Kyle Kuzma. Who saw that coming?

Fox often times looked lost in his rookie season. This year, Fox has often looked like the best player in his class. That’s improvement.

Some feel that sophomores shouldn’t win this award because improvement is almost expected after a rookie season. If that’s your philosophy, then Siakam is your guy. The third-year forward has become a go-to scorer for the Toronto Raptors, who have gone 8-2 without Kawhi Leonard this season in no small part because of Siakam’s continued improvement. Denver’s Monte Morris and Washington’s Thomas Bryant were G-Leaguers last season but have rescued their teams with their stellar play this season at the NBA level.